Periparturient conditions affecting camels ( Camelus dromedarius ) in Israel and their treatments

The frequency of dystocia in camels is reported to be approximately 1% of births (7) and not much has been published on this subject (1). Nevertheless, the economical impact on one family caused by loss of dam or calf due to dystocia can be very heavy, especially in Israel where most Bedouin families only own one or two female camels for milking. Other periparturient conditions such as prolapse and torsion of the uterus have been reported in camels (2, 3, 6, 8, 12) and are also of economical importance. Retention of fetal membranes is uncommon in camels although some cases are said to be fatal (1).


s INTRODUCTION
The frequency of dystocia in camels is reported to be approximately 1% of births (7) and not much has been published on this subject (1).Nevertheless, the economical impact on one family caused by loss of dam or calf due to dystocia can be very heavy, especially in Israel where most Bedouin families only own one or two female camels for milking.Other periparturient conditions such as prolapse and torsion of the uterus have been reported in camels (2,3,6,8,12) and are also of economical importance.Retention of fetal membranes is uncommon in camels although some cases are said to be fatal (1).
To the knowledge of the author, this is the first report of occurrence, treatment and outcome of pathological periparturient conditions in camels in Israel.Because the study includes a relatively large number of cases, it might help improve our understanding of the etiology and therapeutical aspects of these conditions.

Cases and animals
All cases were presented to a private ambulatory clinic between January 1995 and April 1999.The clinic operated in the Negev, a semiarid to arid area in Southern Israel.The camel population in the area was estimated at 2500.Practically all camels were owned by Bedouins who usually kept one or two camels tethered near home for milking.Camels were usually fed wheat or barley hay or straw, with or without a supplement of grain, and usually without access to grazing.Documentation of each case included history, clinical symptoms and treatment.When possible, contact was made with the owner in order to follow up on the case.

Procedures Mutation of the fetus
Epidural anesthesia using 3-4 cc lidocaine 2% with epinephrine (Xylocaine ® , Vitamed, Israel) injected between the last sacral and first coccygeal vertebrae was used in most cases.Uterus relaxation was achieved by injecting 100 mg of isoxsuprine (Vitamed, Israel) intravenously (i.v.).Repositioning of the calf was done while the dam was standing.

Summary
This paper summarizes cases of pathological periparturient conditions found and treated in camels, by a private ambulatory clinic in the Negev region of Israel, during the years 1995-1999.A total of 39 camels were presented with the following periparturient conditions: 27 camels with dystocia, 9 camels with prolapse of the uterus, and 3 camels with retention of the placental membranes.The main causes for dystocia were malposture of the fetus and torsion of the uterus, but other causes were also found.In Israel, the practice of keeping camels tied with no exercise could serve as a risk factor for most of these conditions.Most published literature on periparturient conditions in camels is limited to case reports.The present paper, which includes a relatively large number of cases, could be of importance to help understand the etiological aspects of these conditions.

Cesarean section
Sedation was induced by administration of xylazine 0.12 mg/kg i.v.(Vitamed, Israel).The dam was positioned in sternal recumbency and the operation was performed via the left upper flank.

Prolapse of the uterus
Owners were advised to tie the animal in sternal recumbency and wrap the uterus in a clean wet cloth.In case the uterus was badly wounded and/or the mucosa was severely necrotic, or if the uterus could not be repositioned, a ligation was applied at the level of the vagina and the uterus was amputated.Reposition of the uterus was performed preferably with the dam standing, without sedation but with epidural anesthesia as described above.Prior to repositioning, the uterus was placed on a plastic box and held by two helpers.The clinician was positioned between the helpers, behind the camel.The uterus was thoroughly rinsed and pushed back in place.After pushing uterine horns as far back as possible, a plastic bottle held by the bottleneck was used as an extension of the arm to make sure the tips of the horns were not inverted.The uterus was then rinsed with cold water using a hose or a tube and funnel.Finally, oxytocin and antibiotics were administered as previously described.

Retention of placental membranes
Oxytocin (30-50 IU) was injected i.v.After 5-10 min the membranes were removed manually.Antibiotics were administered as previously described.

Dystocia
During the study period, 27 camels incurred dystocia.Details of these cases are summarized in table I. Seventeen of these cases (63%) were caused by malposture or malpresentation of the calf.In all cases but one, the calf was dead by the time the clinician checked the dam.Fetotomy was performed in ten cases.
Mutation of the fetus was attempted in four cases of bilateral hock flexion, and one case of retroflexion of head and neck.Two of these dams died, one of them two months later due to chronic, suppurative peritonitis originating from a tear in the vagina that occurred during the mutation and was sutured post-partum.
During the study period, four cases of torsion of the vagina and uterus were diagnosed.All torsions were to the right (clockwise).
In one case a concurrent vaginal rupture was diagnosed through which the head and neck of the calf displaced to the abdominal cavity of the dam.Consequently, the dam was euthanized.In another case the dam was rolled and in two cases cesarean section was performed after rolling failed.In both latter cases the dams rejected the calves after the operation.
The remaining cases of dystocia were caused by uterine inertia (two cases), presence of a macerated calf in the uterus (one case), arthrogryposis (one case), a relatively oversized calf (one case) and prolapse of a gravid uterus horn through a rupture in the vagina (one case).

Uterine prolapse
During the study period, nine cases were treated.The details are summarized in table II.Average time between parturition and prolapse was approximately 4 h (range 0-10 h).In four out of seven cases the dam survived reposition.No camel survived amputation of the uterus although in one case the uterus was prolapsed for three days until the clinician was summoned.

Retention of placental membranes
Three camels were presented with retention of the fetal membranes for more than 4 h post-partum.The membranes became loose shortly after administration of oxytocin and were manually removed without difficulties.The owners reported no further complications.

s DISCUSSION AND CONCLUSION
Most published data on dystocia in camels is limited to case reports (3,5,10,11).In this study, a large percentage of camels (63%, 17/27) suffered from dystocia due to malposture and malpresentation of the fetus.The estimated time between owner noticing symptoms that could be attributed to stage II of labor (i.e.frequent lying and standing and/or passage of allantoic fluid from the vulva and/or powerful contractions of the abdominal muscles) and arrival of clinician was very long (average 30.9 h, range 4.5-120 h).This was mainly due to the inability of many owners to recognize initiation of the partus but also because of time wasted on lay assistance.Both can be attributed to lack of experience of the owners in recognizing and managing dystocia.
All four cases of uterine torsion in this study were clockwise.
Clockwise torsion seems to be more common in Old and New World camelids (2,3,4), although some authors suggest that anticlockwise torsion should be more common (7).
Reports on prolapse of the uterus are rare (6,8,12).Reposition of the uterus was achieved much more easily when the camel was standing.Time from partus to prolapse was similar to that found in cattle.
Pregnant cows kept in close confinement and those suffering from periparturient hypocalcemia are more prone to difficulties such as uterine inertia, torsion of the uterus and prolapse of the uterus (9).In Israel, where most camels are kept tied near the tent with no exercise, confinement could serve as a risk factor for dystocia and prolapse of the uterus.Hypocalcemia could also play a role in the etiology of these cases in Israel.Unfortunately, serum calcium levels were not checked in this study.Nevertheless, severe cases of hypocalcemia have been found in lactating camels in Israel (13).
In the opinion of the author, mutation of a malpostured calf should be restricted to cases in which the calf is alive.The dam should stand, and a uterus relaxant should be used.It must be kept in mind that the risk of tearing the vagina or uterus is extremely high due to the long extremities of the calf.Therefore, it might be wise to perform a cesarean section in many of these cases.If the calf is dead and the cervix is sufficiently dilated, fetotomy is the treatment of choice.If the cervix is not sufficiently dilated, a cesarean section must be performed.In case the dam is severely septic, salvage slaughter or euthanasia should be considered.
Prognosis for future conception and birth is unknown because owners tend to sell the treated camels after they recover and because of difficulties in performing a proper follow-up on the cases.